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Integration of multiscale entropy and BASED scale of electroencephalography after adrenocorticotropic hormone therapy predict relapse of infantile spasms

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Abstract

Background

Even though adrenocorticotropic hormone (ACTH) demonstrated powerful efficacy in the initially successful treatment of infantile spasms (IS), nearly half of patients have experienced a relapse. We sought to investigate whether features of electroencephalogram (EEG) predict relapse in those IS patients without structural brain abnormalities.

Methods

We retrospectively reviewed data from children with IS who achieved initial response after ACTH treatment, along with EEG recorded within the last two days of treatment. The recurrence of epileptic spasms following treatment was tracked for 12 months. Subjects were categorized as either non-relapse or relapse groups. General clinical and EEG recordings were collected, burden of amplitudes and epileptiform discharges (BASED) score and multiscale entropy (MSE) were carefully explored for cross-group comparisons.

Results

Forty-one patients were enrolled in the study, of which 26 (63.4%) experienced a relapse. The BASED score was significantly higher in the relapse group. MSE in the non-relapse group was significantly lower than the relapse group in the γ band but higher in the lower frequency range (δ, θ, α). Sensitivity and specificity were 85.71% and 92.31%, respectively, when combining MSE in the δ/γ frequency of the occipital region, plus BASED score were used to distinguish relapse from non-relapse groups.

Conclusions

BASED score and MSE of EEG after ACTH treatment could be used to predict relapse for IS patients without brain structural abnormalities. Patients with BASED score ≥ 3, MSE increased in higher frequency, and decreased in lower frequency had a high risk of relapse.

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Data availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank the medical staff at the pediatric department of Chinese PLA Hospital for their assistance with this study.

Funding

This research was partially supported by National Natural Science Foundation of China (Nos. 62171028, 62001026), the Natural Science Foundation of Beijing, China (No. 7222187), the Medical Big Data and Artificial Intelligence Research and Development Project of the Chinese PLA General Hospital (No. 2019MBD-004), the Epilepsy Research Fund of China Association Against Epilepsy (No. CU-B-2021-11), and the Nutrition and Care of Maternal & Child Research Fund Project of Guangzhou Biostime Institute of Nutrition & Care (No. 2021BINCMCF030).

Author information

Authors and Affiliations

  1. Senior Department of Pediatrics, Chinese PLA General Hospital, Beijing, 100000, China

    Lin Wan, Gang Zhu, Jian Chen, Xiu-Yu Shi, Jing Wang, Li-Ping Zou & Guang Yang

  2. Department of Pediatrics, the First Medical Centre, Chinese PLA General Hospital, Beijing, China

    Lin Wan, Gang Zhu, Jian Chen, Xiu-Yu Shi, Jing Wang, Li-Ping Zou & Guang Yang

  3. Medical School of Chinese People’s Liberation Army, Beijing, China

    Lin Wan, Gang Zhu, Xiu-Yu Shi, Li-Ping Zou & Guang Yang

  4. School of Information and Electronics, Beijing Institute of Technology, Beijing, 100081, China

    Chu-Ting Zhang, Wen-Bin Shi & Chien-Hung Yeh

  5. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China

    Xiu-Yu Shi, Li-Ping Zou & Guang Yang

  6. Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Bo Zhang

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Contributions

WL, ZCT and ZG contributed equally to the manuscript. WL contributed to the conception and design of the study, and wrote the first draft of the manuscript. ZCT wrote the first draft of the manuscript. ZG performed the data analyses, and wrote the first draft of the manuscript. SXY, WJ and ZLP performed the acquisition of data. ZB, CJ and SWB performed the data analyses. YCH and YG contributed to the conception and design of the study. All the authors helped to revise the manuscript regarding important intellectual content. All the authors approved the final version for publication.

Corresponding authors

Correspondence to Chien-Hung Yeh or Guang Yang.

Ethics declarations

Ethical approval

This was a retrospective cohort study, patient identity remained anonymous, and the requirement for informed consent was approved to waive by the Ethics Committee of First Medical Center of PLA General Hospital due to the observational nature of the study (S2020-337-01).

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. We confirm that we have read the journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. The authors have no conflict of interest to declare.

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Wan, L., Zhang, CT., Zhu, G. et al. Integration of multiscale entropy and BASED scale of electroencephalography after adrenocorticotropic hormone therapy predict relapse of infantile spasms. World J Pediatr 18, 761–770 (2022). https://doi.org/10.1007/s12519-022-00583-9

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